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Old Sep 20th, 2010, 16:09 PM   1
going_crazy
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GD levels rising at 37 weeks?


Hi all
I was diagnosed early with GD at 20 weeks, but my sugar levels have been under 8.4 since and I haven't needed any medication, nor have I particularly changed my diet.

I saw the diabetic midwife last week and showed her my numbers which were still well under 8.4 (only one reading was this high) one hour after meals and my morning level has ALWAYS been under 5.2. She was quite happy that although my baby is measuring very big, I wouldn't be induced, but could have a sweep at 39 weeks. I was quite happy with this as I can only be induced certain ways anyway due to previous c-section.

HOWEVER..... Todays readings have been a bit high:
Morning: 4.9
1 hour after breakfast: 6.7
1 hour after lunch: 8.4
1 hour after dinner: 9.6 (although this dinner did include mashed potato which I don't normally have) I also tested again 1hr 30mins after eating and the reading had gone down to 7.8

I am not seeing the midwife again until next weds when I'll be 38+4. At my last scan (35+4) baby was estimated at 8lb 4oz with an estimated birth weight of 10lb 5oz (40 weeks)

Should I be worried?? Should I ask for an earlier induction?? What is classed as a very high reading??

Thanks in advance for any advice



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Old Sep 21st, 2010, 02:58 AM   2
sarafused
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I think thats high. GD sugars shouldnt be over 7.8 an hour after food!

If you are in the UK, you check the guidelines for GD under NICE.

Quote:
If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy.
Page 19, http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

The levels for GD are lower than normal diabetes.

I had GD in my last pregnancy and it was well diet controlled and baby was 8lb5oz at 38+1 (he was tall and all muscle, no large stomach, fat etc). Personally I think your levels are too high and Id be asking for an earlier induction if the levels stay higher. Im sure you are aware it increases the risks of problems for both of you.

My levels have all been well under the limits, only in Finland our morning level has to be under 5.5. Ive been getting mostly 5.4, now with the odd 5.6 thrown in and and a one off 5.7. I have to see the doctor tomorrow incase I need insulin just for this figure alone.

I think you would be best of calling either your midwife or the hospital directly about your levels and having it checked over.



 
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Old Sep 21st, 2010, 05:09 AM   3
thesmiths88
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I just wanted to query - I have been told to test 2 hours after food and that my levels need to be lower than 7.8, ideally below 7.0, even though the NICE guidelines do specifically state 1 hour. I queried this and didn't really get a comprehensive answer though! If I had to test 1 hour after food, I don't think any of my readings would be within range!



 
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Old Sep 21st, 2010, 06:45 AM   4
going_crazy
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Quote:
Originally Posted by thesmiths88 View Post
I just wanted to query - I have been told to test 2 hours after food and that my levels need to be lower than 7.8, ideally below 7.0, even though the NICE guidelines do specifically state 1 hour. I queried this and didn't really get a comprehensive answer though! If I had to test 1 hour after food, I don't think any of my readings would be within range!
Hi!
This is exactly what I've been trying to query since being diagnosed.... I have had no luck with answers either, and I have had several different information thrown at me which is all very confusing One consultant told me that my morning level was the one to keep an eye on and if that started to go high, it would indicate the GD worsening??? Another consultant told me that so long as my levels remained under 9 (1 hour after food) I wouldn't need medication??? I feel like shouting "COME ON PEOPLE..... THE SAME INFO WOULD BE NICE!!"

If I test my levels after 1hr, I can have mixed results. If I test after 1.5 hrs, they are all under 6, and if I tested 2 hours after food, my levels would be perfect no matter what I eat!

So, I really have no idea what to think. My amniotic fluid levels are perfect and baby seems fine, just big (but my other babies have been big, my last DD was 9lb 8oz without GD).

I think I will ask for a sweep at 38/39 weeks, but I don't want to do for the full induction really as I am only allowed the gel, no pessary and no drip.

I cannot wait for baby to be here!! xxx



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Old Sep 21st, 2010, 06:47 AM   5
going_crazy
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Quote:
Originally Posted by sarafused View Post
I think thats high. GD sugars shouldnt be over 7.8 an hour after food!

If you are in the UK, you check the guidelines for GD under NICE.

Quote:
If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy.
Page 19, http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

The levels for GD are lower than normal diabetes.

I had GD in my last pregnancy and it was well diet controlled and baby was 8lb5oz at 38+1 (he was tall and all muscle, no large stomach, fat etc). Personally I think your levels are too high and Id be asking for an earlier induction if the levels stay higher. Im sure you are aware it increases the risks of problems for both of you.

My levels have all been well under the limits, only in Finland our morning level has to be under 5.5. Ive been getting mostly 5.4, now with the odd 5.6 thrown in and and a one off 5.7. I have to see the doctor tomorrow incase I need insulin just for this figure alone.

I think you would be best of calling either your midwife or the hospital directly about your levels and having it checked over.
I agree that the recent levels are high - definately, yet when I asked the diabetic midwife on the phone this morning, and gave her my morning readings (fasting=4.4 1hr after breakfast=6.7) she told me not to worry and everything was fine????

I really don't understand it all xxx



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Old Sep 21st, 2010, 08:24 AM   6
bexyd31
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Quote:
Originally Posted by going_crazy View Post
Quote:
Originally Posted by sarafused View Post
I think thats high. GD sugars shouldnt be over 7.8 an hour after food!

If you are in the UK, you check the guidelines for GD under NICE.

Quote:
If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy.
Page 19, http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

The levels for GD are lower than normal diabetes.

I had GD in my last pregnancy and it was well diet controlled and baby was 8lb5oz at 38+1 (he was tall and all muscle, no large stomach, fat etc). Personally I think your levels are too high and Id be asking for an earlier induction if the levels stay higher. Im sure you are aware it increases the risks of problems for both of you.

My levels have all been well under the limits, only in Finland our morning level has to be under 5.5. Ive been getting mostly 5.4, now with the odd 5.6 thrown in and and a one off 5.7. I have to see the doctor tomorrow incase I need insulin just for this figure alone.

I think you would be best of calling either your midwife or the hospital directly about your levels and having it checked over.
I agree that the recent levels are high - definately, yet when I asked the diabetic midwife on the phone this morning, and gave her my morning readings (fasting=4.4 1hr after breakfast=6.7) she told me not to worry and everything was fine????

I really don't understand it all xxx
Hey Going Crazy,

I'm not an expert at all, but your morning reading sounds ok. I have been advised that you should be aiming for your fasting level (and before meal reading) to be below 6 and 1hr after meals it should be under 7.8, which they both are.

Obviously, some of your after meal readings have been a little high, so I would re-confirm this with your diabetic midwife as it seems your body is slightly less tolerant than it was - this is probably because your placental hormones have increased as you are going along in your pregnancy. My consultant did explain to me that this would happen and would probably need to continue increasing my dose of insulin to manage this until my babes is born. They may just want to monitor this as you are quite far along and everything baby seems to be doing fine

I was also told that the reason they like to measure GD sugars 1 hr after food instead of 2hrs (for normal type 2 diabetes) is because within that hour your sugar will cross over to the placenta. What they are looking for with GD is the frequency of highs (either over 6 before meals or over 7.8 after meals), as this will be the number of times your baby has made extra insulin to manage the extra sugar (which obviously impacts on babes growth, amniotic fluid etc etc). They will use how high your readings are to decide if you need medication, and how much medication you need. I think this explanation was very simplistic, but I guess it kind of makes sense

Well, thats how my consultant explained it to me, but it seems that what one consultant says can be very different to the next and very different compared to where you live too!

I don't know what a really high reading is but I know the week I was trying to manage my GD on diet and exercise alone, I could eat a bowl of plain porridge and I would have a reading of 13.6!!

My two sons were big babies too, 10lb 2oz (born at 42 weeks) and 9lb 8oz (born at 40 weeks) without having GD - I think some of us just grow gorgeous big uns

Good luck, your so close now, how exciting!!

Bexy x x



 
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Old Sep 21st, 2010, 10:51 AM   7
Tanikit
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They are much stricter with gestational diabetics than they are with type 1 diabetics. I am a type 1 and they told me right now it is more important to get my levels up and not allow them to drop below 4.0 than it is to prevent the occassional high, so even values of 12.0 are ok - though I don't like that.

If it is going to 9.6 after every meal then there is a problem, but once in a while will not harm your baby - just make her big. Your fasting values seem very good, so perhaps try and change your diet to even lower GI foods - sometimes things like rice can push sugars high for a short while after eating.

Also remember that u/s scans are not the most accurate at diagnosing weights so it is possible your baby could be much smaller (or bigger) than they say. I was induced last time at 38 weeks and my baby weigheed 8 pounds 3 ounces and I had had a few sugar levels in the 20s during that pregnancy - which is why I say if it happens once in a while it is not the end of the world. During labour itself it might be wise to monitor your sugar levels as any high values then can result in a baby with very low sugar levels after the birth - DD's did drop to 1.2 after birth and my sugars had not been high during labour though they may have peaked during the actual pushing when I was no longer being monitored for the sugars.



 
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Old Sep 21st, 2010, 13:34 PM   8
going_crazy
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Bexy - thank you so much for your reply, and I agree that some of us are just designed to have big babies! I will be keeping a close eye on my levels, but after lunch today they were 5.6....... makes me think that my body was just having a crap day yesterday!!

Tankit - thank you too for your reply..... You have put my mind at ease that the very occasional high-ish level isn't going to harm bubba

I have got my last growth scan tomorrow afternoon, so it will be interesting to see if she has gotten much bigger of if she has levelled out a bit! I will let you know!!!
My next appointment with the diabetic midwife is Friday, when I will be 38 weeks, so I'll ask her then if I am able to have a sweep next week (just to try and get things going as naturally as possible!)


Thanks again ladies



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